What is the List of Reimbursable Products and Services (LPPR)?
The French List of Reimbursable Products and Services (LPPR) defines, beyond medicines, the products considered as potentially important in overall therapeutic care (products whose medical use has been proven) and whose cost, if applicable, is borne by the French health insurance. It not only covers the device itself, but also the services required for its proper use.
In particular, it includes medical devices used for the diagnosis or treatment of illnesses (e.g. diabetes) or injuries (dressings), daily living aids (ostomy bags, medical oxygen…), dietary foods for special medical needs, external orthotic and prosthetic devices (hearing devices, brace, orthopaedic shoes…), implantable medical devices or mobility equipment for the physically disabled.
To be reimbursed, LPPR products must have been prescribed by a licensed health professional (doctor, dentist, physiotherapist, midwife, podiatrist, nurse), on a separate prescription from all other prescriptions. Furthermore, they must have been prescribed for an illness for which their use is authorised (i.e. according to their indications).
To be reimbursed, medical devices must be included in the List of Reimbursable Products and Services (LPPR) provided under Article L.165-1 of the French Social Security Code.
PERSONAL INJURY AND COMPENSATION
Have you suffered physical injury?
You are in a position to receive compensation from a third party: this article concerns you.
PRINCIPLE: For any physical injury suffered by an individual that needs to be addressed, the rule of full reparation must be a priority for all damages suffered, and as a result of the accident, whatever they may be.
IN PRACTICE: Too often victims, although entitled to full compensation are offered reduced compensation, not including all items of possible damage (loss of earnings, home help, vehicle conversion, cost of ortho-prosthetic device) or at reduced amounts. The practice is easier and more frequent for an insurer or a guarantee fund insofar as victims are unaware of what they are entitled to.
Most situations arising from physical injury that have resulted in further disability (loss of autonomy, amputation, musculoskeletal disease) and which, among other things, involves compensation from an insurance or guarantee fund, are rarely fully defined. Too often, compensation for the damage suffered is reduced or under-estimated, or even non-existent.
WHAT DOES THIS RIGHT CONSIST IN? Physical Injury Law is a component, still unknown to the general public, of the Law, which allows patients-victims of physical injury to be fairly compensated, with the aim of compensating the losses sustained, whatever the cause of the damage (traffic accident, accident at work, employer’s fault, domestic accident, aggression, medical accident, etc.).
We encourage our patients concerned by these situations, to seek advice on their own initiative from independent consultants, most often specialised lawyers.
Indeed, the expert is most often provided by the insurance or third party financial institution. He is contractually bound, with an objective to minimise costs, which no longer guarantees his objectivity to ensure the best compensation.
Seeking assistance from a lawyer or an independent expert, on his own initiative, allows the patient-victim to be correctly accompanied and obtain full compensation. The lawyer or expert will consider the disability as a whole and include all aspects of its implications (from facts and over time, a comprehensive consideration of effects on professional, personal and sexual issues, etc.) . He will conduct the expert evaluations required to reveal and value all components to be compensated.
The lawyer or expert chosen by the patient-victim, will exclusively:
- Be committed to representing and maximising your interests, based on legal levers and referrals specific to health professionals.
- Assist you in the counter expertise, by involving professionals specifically deployed (medical-expert, occupational therapist, ortho-prosthetist advisors…)
- Negotiate a compensation higher than that proposed by insurers and obtain provisions.
- Assist you in legal proceedings if they are required.
Today in France, less than 10% of personal injury cases receive assistance from expert consultants and/or specialised lawyers.
However, their involvement always allows compensation, several times higher than that spontaneously offered by an insurer or a fund for unassisted victims, to be obtained.
Through compensation, patients are sure to benefit from complete multidisciplinary care and, it gives them the possibility to access technologically advanced medical equipment not restricted by LPPR specifications (intelligent orthosis, sport prosthesis, prosthetic components and ultra-modern materials, high quality aesthetic finishes, etc.)
“I had a minor accident, a car hit me from the rear. My own insurance company did not want to ask for a medical opinion and offered me a fixed sum of 200€. I refused. Although the firm Irrmann & Ferot provides expertise for more important cases, I had the courage to ask for help. An evaluation was requested, and the damages retained: temporary impairments, suffering endured 1,5/7 : a compensation of 2500 €”
“I was the victim of a bicycle accident, I was knocked over by a lorry. I had to have my left leg amputated above the knee. At first, the insurance company said I was at fault and told me that I could not be compensated.
The firm Irrmann & Ferot became involved, and dealt with the insurance company so that I received compensation. Indeed, a cyclist is fully entitled to compensation, except in case of serious fault. I was able to have a bicycle and running prosthesis fitted, which I wouldn’t have obtained without the help of specialised lawyers.”